Background: Tobacco use is the leading cause of preventable
deaths worldwide. The objective of this study was to estimate the burden of
disease attributable to tobacco use and to evaluate the potential impact of increasing
cigarette´s price through taxes in Argentina, Bolivia, Brazil, Chile, Colombia,
Costa Rica, Ecuador, Honduras, Mexico, Paraguay, Peru and Uruguay-countries which
encompass 84% of Latin America´s population.
Methods: A microsimulation model was used
to estimate the chances people have to get sick or die from 17 smoking-related
conditions. An extensive review was conducted to identify key epidemiological
and cost data relevant to each country.
Results: Every year, smoking is
responsible for 293,364 deaths, 862,484 COPD cases (Chronic Obstructive
Pulmonary Disease), 832,791 cardiovascular events, 131,037 cancer diagnoses and
28,098 USD millions in direct medical costs to the health systems in these
countries. The proportion of health expenditure that these burden represent
range from 3.2% in Honduras to 16,6% in Uruguay; and the proportion of the total
GDP (Gross Domestic Product) ranged from 0.3% to 1.5% respectively. The percentage
of attributable health expenditures recovered through tobacco taxes also varies
widely: Mexico, Honduras, Argentina and Chile recover over 45%; in Ecuador tax revenues
reach 40%; Brazil, Costa Rica, Paraguay and Uruguay recover less than 30%, and Bolivia,
Colombia and Peru, less than 10%.
Different
scenarios of cigarette price increases through taxes were modeled for each
country. An example -the case for Brazil- is shown in the table below.
Cigarette price increase through taxes | 25% | 50% | 100% |
Avoided deaths | 68,241 | 136,482 | 272,964 |
Avoided events | 336,099 | 672,199 | 1,344,398 |
Direct costs avoided (USD millions) | 4,866 | 9,732 | 19,464 |
Indirect costs avoided (USD millions) | 2,995 | 8,980 | 8,411 |
[Potential benefts on different scenarios, Brazil]Conclusions: The burden of disease
and related direct health expenditure in Latin America is very high and tax
revenues from the sale of tobacco products are far below the levels needed to
cover it. Increasing cigarette´s price through taxes is an effective
intervention to reduce tobacco-attributable burden of disease and health
expenditures in Latin America.